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Despite the fact that mental disorders are relatively common in the United States (according to the National Institute of Mental Health, more than 46 percent of Americans will experience a diagnosable mental disorder throughout their lifetime), stigma of mental illness remains an ongoing problem.

Only a few decades ago, many people with severe depression and other mental disorders were shunned, placed in straitjackets, and locked away in institutions. And while society has come a long way since then, we still have improvements to make in terms of getting people the help they need while treating them with dignity and respect.

“Stigma related to mental illness is a national health problem,” says Melissa Pinto, PhD, RN, an instructor in the School of Nursing at Case Western Reserve University who studies stigma related to mental health. “Young people hear messages about mental health disorders from an early age — as a result, many of them are scared to be around people with mental illness.”

One serious effect of the stigma around mental disorders is that two-thirds of affected people don’t seek help, says the National Alliance on Mental Illness; the main reasons people give to explain why include fear of disclosure, rejection, and discrimination.“Stigma reinforces attitudes and behaviors that prevent many people with symptoms of mental illness from seeking the treatment they need,” Pinto says.

According to the U.S. Surgeon General’s Report on Mental Health, in its most severe form mental health stigma can lead people to avoid socializing and working with — including renting to and hiring — people with mental disorders, especially severe disorders such as schizophrenia.

You may think you have no preconceived notions about people with depression or other forms of mental illness, yet you may unwittingly be guilty of perpetuating mental health stigmas. Expressions of mental health stigma are often displayed during daily interactions in fairly subtle and complex ways, Pinto says.

Subtle Signs of Stigma Against the Mentally Ill

The following examples of mental health stigma may help you reach an “aha” moment with regard to your own actions and attitudes:

Mental illness in the media. “On television, characters with a mental health disorder often play the villain,” Pinto says. “In order to eliminate mental illness stigma, these media portrayals need to become more accurate.” One step forward is the encouraging depictions of psychiatry on shows such as Monk,The Sopranos, and In Treatment, says Howard Belkin, MD, JD, an assistant professor at the Oakland University William Beaumont School of Medicine and a psychiatrist at the Birmingham Counseling Center in Royal Oak, Mich.

Phrases like “She’s lost her marbles” or “He’s not playing with a full deck.” It’s easy to throw terms such as these around in casual conversation, but doing so promotes mental health stigma. “Instead, use care in the way you describe someone with a mental health disorder,” Dr. Belkin says. “Remember: The mental illness is not the person’s fault, and she may be doing everything she can to try to get better.”

“Crazy” Halloween costumes. Considering going next Halloween as a psycho killer or straitjacketed mental ward patient? Both costumes strongly promote mental health stigma and falsely portray all people with mental illness as violent. “Unfortunately, some people with mental illness, particularly paranoia, can have a tendency toward violence, and when they become violent it can be tragic, as well as heavily covered by the media,” says David M. Reiss, MD, interim medical director at Providence Behavioral Health Hospital in Holyoke, Mass. “However, what the media does not remind the public is that the vast majority of people with mental illness are not violent. Overall, statistically, a person with mental illness is no more likely to become violent than a person without mental illness.”

Common — but wrong — assumptions about people with mental illness. “For example, people may assume someone with depression or another mental illness is unstable, lazy, untrustworthy, unintelligent, or incapable," when that's not the case, says Mary Pender Greene, LCSW-R, a group psychotherapist in private practice in New York City.

Verbal innuendoes. As you talk about someone with a mental illness, you may pair certain words with a change in your tone of voice. For example, you may whisper the term “depression” or “bipolar.” “People pick up on these cues, which communicate depression stigma to the listener,” Pinto says.

Isolation of people with mental illness. When talking to someone with depression or another mental health problem, you may unconsciously step back to increase your physical distance from the person, or turn away from him or her. “You may also speak to the person with mental illness in an angry or condescending tone or as if he was a child,” Pender Greene says. People with mental health disorders are also more often ignored in group social situations and generally more rejected by others.

Disrespect for the gravity of depression and other mental health problems. Telling someone with mental illness to “get over it” or “snap out of it” is not only insensitive, it also promotes mental health stigma, Pender Greene says. Instead, she suggests pushing past the misconceptions floating around by educating yourself with the facts.

Overall, the best way to avoid promoting mental health stigmas is to give people with depression and other forms of mental illness the respect and kindness they deserve. “Good mental health is a goal we should all seek,” Belkin says. “We need to show understanding and compassion for those suffering from both minor and major mental health problems. If the topic of depression or other mental illness comes up in conversation, be empathetic. After all, you or one of your loved ones may one day suffer from mental health symptoms.”

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